Std classic

  • View
    273

  • Download
    2

Embed Size (px)

DESCRIPTION

 

Text of Std classic

  • 1. InstituteforMicrobiology, Medical Faculty of Masaryk Universityand St. Anna Faculty Hospitalin Brno Agents of classical venereal infections

2. Classical venereal infections

  • Gonorrhoea(rudely: the clap)
  • Neisseria gonorrhoeae
  • Syphilis(in Central Europe also: lues)
  • Treponema pallidum
  • Chancroid(soft chancre, ulcus molle)
  • Haemophilus ducreyi
  • Lymphogranuloma venereum
  • Chlamydia trachomatisL 1 , L 2 , L 2a , L 3

3. Neisseria gonorrhoeae 4. Clinical forms ofgonorrhoea

  • Infections o f lowerparts of urogenital tract
  • Infections ofupperparts of urogenital tract
  • Otherlocalizedinfections
  • R are gonococcalinfections:disseminatedones (skin, arthritis, meningitis, endocarditis)

5. GO: infections of the UGT

  • Urethritis
  • Ep i d i dym i t i s
  • Cervicitis
  • Urethritis
  • Bartholinitis
  • Endometritis
  • Salpingitis, adnexitis( PID , pelvic inflammatory disease) ->sterility!

6. GO: other localized infections

  • and :
  • proctitis
  • pharyngitis
  • blenorrhoea neonatorum
  • :
  • peritonitis (Fitz-Hugh syndrome)
  • perihepatitis (Curtis syndrome)

7. www. cehjournal . org /extra/ts04_13. htm Blenorrhoea neonatorum 8. GO: complications

  • :
  • prostatitis
  • periurethral abscesses
  • :
  • cervicitis chronica
  • tuboovarial abscess
  • adnexitis chronica -> sterility
  • graviditas extrauterina

9. GO: laboratory diagnostics I

  • Direct detection only:
  • microscopy
  • culture
  • molecular biology tests
  • Sampling places:
  • urethra
  • cervix, urethra , rectum, pharynx (if necessary)

10. GO: laboratory diagnostics II

  • Way of sampling:
  • always 2 swabs
  • the first oneinoculate directly on media(warmed, not from the fridge), orput it into atransport medium , transport it at ambient temperature ,from the second onemake a film on the slide
  • Microscopy(Gram): importantin acute gonorrhoea in males ,
  • symptomatic gonorrhoea in females

11. 12. GO: laboratory diagnostics III

  • Mediafor gonococci:
  • Combinen on-selectivechocolate agar
  • with a selectivemedium with antibiotics
  • Always fresh ( moist ), with addedCO 2 (candle jar), read after 24 and 48 hrs
  • Identification :
  • biochemistry (oxidase +, glucose +, maltose -)
  • serology (slide agglutination)
  • molecular biologic confirmation tests

13. GO: therapy

  • C eftriaxoneorciprofloxacin usually in a single dose , because of potential concurrentChlamydia trachomatisinfection: in a combination with doxycycline or azithromycine
  • Nowadays, many strains ofN. gonorrhoeaeareresistantto penicillin & tetracyclines

14. Author: MUDr. Petr Ondrovk 15. Syphilis: course

  • From the very beginning: syphilis =systemic disease!
  • Earlysyphilis:primary(ulcus durum)
  • secondary(mostly rash)
  • early latent
  • Latesyphilis:latent
  • terciary(gummas, aortitis,
  • paralysis progressiva,
  • tabes dorsalis)
  • Congenitalsyphilis: early and late

16. Syphilis: therapy

  • One night with Venus, the rest of life with Mercury
  • Ehrlich and Hata: preparation No 606 salvarsan
  • von Jauregg: malaria (because of high fever)
  • Nowadays, the drug of choice ispenicillin
  • Primary syphilis:
  • benzathin penicillin (2,4 MIU)1 dose
  • Secondary and late syphilis:
  • benzathin penicillin (2,4 MIU)3 times after 7 days

17. 18. Syphilis: laboratory dg I

  • Direct detection
  • From exudative lesions only (mostly from ulc usdurum)
  • darkfield examinationPCR immunofluorescence
  • Indirect detection(serology)
  • = mainstay of laboratory diagnosticsof syphilis
  • Two types of serologic tests:
  • with nonspecific antigen ( cardiolipin )
  • with specific antigen ( Treponema pallidum )

19. 20. Syphilis: laboratory dg II

  • Testswith cardiolipin ( nontreponemal ):
  • RRR, VDRL, RPR
  • fast, cheap, positive early, reflecting the activity, but often falsely positive
  • Treponemal tests:
  • TPHA, ELISA, WB,FTA-ABS, TPIT
  • sensitive, more expensive, more specific, but positive later, remaining positive for life

21. Screening:cardiolipin test(RRR) +TPHA 22. Poster, 1940 23. Soft chancre (chancroid)

  • Agent of ulcus molle:Haemophilus ducreyi
  • Occurrence: the tropics
  • Course: genitalulcerations(easier transmission of HIV) & purulent lymphadenitis
  • Dg: onlycultureon enriched media(chocolate agar with supplements),3 days at 33 C in 10% CO 2

24. Lymphogranuloma venereum

  • Agent of LGV:Chlamydia trachomatis serotypesL 1 , L 2 , L 2a , L 3
  • Occurrence: the tropics and subtropics
  • Course: purulentlymphadenitis(tropical bubo)&lymphangoitis withfistulae & scarsdevastating the pelvic region in females
  • Dg: mostlyserology CFT with the common antigen of chlamydiae

25. 26. Homework 4 solutionGerrit van Honthorst (1590-1656): Dentist (1622) 27.

  • Homework 5